Surveillance Strategies in African Refugees in their Country of Asylum
National Center for Emerging and Zoonotic Infectious DiseasesDivision of Global Migration and Quarantine
Maurice Ope, MBChB, MPH, MScImmigration Health - Africa Field Program
Division of Global Migration and Quarantine
International Conference on Migration Health October 1 -3, 2018
Photo credit: Ben Curtis/ Associated press
Photo credit: International Organization for Migration
Why cross-border collaboration? (1/3) Several Regional Economic
Communities (RECs) in Africa
Common Market Established by RECs Intended to foster economic
growth and social development
Free movement of goods, labor, and services
Ill travelers may seek care across international borders
Why cross-border collaboration? (2/3) Port health staff in official
crossings More unofficial than official
crossings Volume of travelers may be
higher in unofficial crossings
Purpose of travel Seek health care Mortuary services Pasture
Source: The East African Online (http:// www.theeastafrican.co.ke)
Why cross-border collaboration? (3/3) Routes and destination
of travel
Volume of movement at the borders
Health services available at borders
Strengthening cross-border collaboration (1/2)
Need a framework for collaboration across borders Sensitivities on information sharing Who has authority to share information Agreement of local and national governments
Identify stakeholders and their roles at borders
Map and understand border characteristics
Strengthening cross-border collaboration (2/2)
Joint response planning and training Trainings, tabletop and field simulation exercises including
communities Cross-border meetings
Binational information sharing
Acute Refugee Crisis (1/4)
Multiple factors promote disease transmission High influx of refugees Overcrowding Inadequate infrastructure Poor nutritional status Overwhelmed public health
system
Photo credit: CARE Australia
Acute Refugee Crisis (2/4) Focus is on disease prevention and control
Site planning Clean water Vaccination Vector control Personal protection
Data are needed to Detect epidemics Determine the quality, coverage and effectiveness of response
programs Prioritize interventions
Acute Refugee Crisis (3/4) Priority diseases
Diarrheal illness Respiratory illness Measles Malaria Meningitis Other epidemic-prone diseases
Identify health needs of arriving refugees Photo credit: Africa Field Program,
Dr Rachel Eidex
Syndromic surveillance to detect outbreaks Inadequate laboratory services False outbreak alarms for diseases with nonspecific symptoms
Acute Refugee Crisis (4/4) Set up refugee screening sites
Transit centers located at borders Reception centers at the camps
Disease outbreaks still likely Undetected infectious disease incubating among newly arriving
refugees
Prepare communities to ensure timely detection and response
Stable Refugee Situation (1/5) Focus on infrastructure improvement and capacity
building Providing safe water and improving sanitation Monitoring morbidity and mortality Detecting disease outbreaks
Some events increase likelihood of disease outbreaks
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Epidemiological week
Malaria in Kakuma Refugee Camp: Jan - Dec 2016
Stable Refugee Situation (3/5) Movement between country of origin and refugee camps
Insecurity in country of origin then health infrastructure remains poor
Unvaccinated arrivals Multidrug -resistant infections
Maintain situational awareness of conditions in country of origin Factors like drought, worsening insecurity may force influx into the
camps Maintain contact with partners working in country of origin
Stable Refugee Situation (4/5)
Ebola virus Measles Monkeypox
Vaccine-derived polio virus type 2 Cholera Yellow fever
Stable Refugee Situation (5/5) Additional priority diseases
Tuberculosis HIV
Surveillance strategies Syndromic surveillance Laboratory-based surveillance
• Including drug resistance Sentinel surveillance
Africa Field Program staff photo in a refurbished camp laboratory
US Refugee Admission Program (USRAP): Immediate Pre -departure Period (1/3 )
Ensuring safe travel Protect the health of refugee
during travel Protect other travelers Prevent importation of
disease to final destination
Known applicant since migration health assessment done
Complex medical conditions stabilized and prepared for travel
Photo credit: Africa Field Program
USRAP Immediate Pre-departure Period (2/3) Protection to refugee
from known diseases Vaccination against
Measles, Mumps, Rubella, polio, tetanus
Presumptive treatment for intestinal parasites
Counterfeit medicines Routine testing of samples
of medications used
Priority diseases that pose serious threat to travel
Photo credit: IOM
USRAP Immediate Pre-departure Period (3/3 ) Monitor closely disease
outbreaks in refugee camps
Check departing refugees daily for signs of illness
Duration of surveillance depends Incubation period Resources available
Photo credit: Africa Field Program
Response to Public Health Events 2007–2018
Pertussis
Multidrug -resistant TB
Polio Photo credit: International Organization for Migration
Conclusion Strong cross-border collaboration is essential
For disease prevention and control prior to acute refugee crisis To determine prevalence of priority diseases and immediate needs
for newly arriving refugees
Surveillance strategies should take into account the priorities and disease transmission factors
Deliberate measures can ensure uninterrupted resettlement despite public health threats
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
National Center for Emerging and Zoonotic Infectious DiseasesDivision of Global Migration and Quarantine
Thank You!
Pharmacy wall, Dadaab Refugee Camp
DefinitionsAsylum seeker• Claims refugee status but claim has not yet been
definitively evaluated
Refugee• Well-founded fear of persecution based on race,
religion, nationality, membership in a particular social group, or political opinion
• Outside their home country
Migrant• Decision to migrate is taken freely
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